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Desmopressin for treating nocturia in men with lower urinary tract symptoms

Review question

Is desmopressin effective for treating nocturia in men?

Background

Nocturia is the bothersome symptom of waking one or more times per night to pass urine. It is common in older men. More than half of men older than 70 years of age have nocturia and there are many reasons for this. Desmopressin regulates urine volume and concentration in the body. It is also a medicine used to treat nocturia.

Study characteristics

The search is up-to-date to 1 August 2017. We identified 14 clinical trials, including 2966 men. We compared desmopressin alone or in combination with other medicines used for urinary problems (such as alpha-blockers or anticholinergics) against placebo (pretend treatment), behavior changes or medicines used for urinary problems alone or in combination. We also compared desmopressin to behavior changes. Most, but not all, studies enrolled only older men.

Key results

Desmopressin may reduce how often men urinate at night in an appreciable number of men compared to placebo when treated for three to 12 months. Serious side effects were not increased. We do not know how desmopressin compares to changes in behavior. The effect on how often men have to urinate at night is likely similar to that of alpha-blockers when given for up to three months (called short-term treatment) without major side effects. Adding desmopressin to an alpha-blocker or an anticholinergic does not seem to work better.

Quality of the evidence

We rated the quality of the evidence and found it to be low most of the time, meaning that we cannot fully trust the results. The included studies were not well designed, were small, and only followed people for a short time (usually three months or less).

Authors' conclusions:

Desmopressin may reduce the number of nocturnal voids in an appreciable number of participants compared to placebo in intermediate-term (three to 12 months) follow-up without increase in major adverse events. We found no evidence to compare its effects to behavior modification. The effect on the number of nocturnal voids is likely similar to that of alpha-blockers short-term with very infrequent major adverse events. There appears to be no added benefit in the combined use of desmopressin with an alpha-blocker or an anticholinergic. The findings of this review were limited by short-term follow-up, study limitations, and imprecision.

Read the full abstract...

Background:

Nocturia is the bothersome symptom of awakening one or more times per night to void. Desmopressin is a commonly used medication for treating nocturia.

Objectives:

To assess the effects of desmopressin as compared to other interventions in the treatment of nocturia in men.

Search strategy:

We performed a comprehensive search of medical literature with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017.

Selection criteria:

We included randomized or quasi-randomized trials. Inclusion criteria were men with nocturia defined as one or more voids per night. Trials of children, adults with primary or secondary enuresis or underlying distinct disorders were excluded.

Data collection and analysis:

Two review authors independently classified studies and abstracted data from the included studies. We performed statistical analyses using a random-effects model and interpreted data according to the Cochrane Handbook for Systematic Reviews of Interventions.

Main results:

We included 14 studies with 2966 randomized men across five comparisons.

Desmopressin versus placebo: based on short-term follow-up (up to three months), desmopressin may have a similar effect on the number of nocturnal voids (mean difference (MD) -0.46, 95% confidence interval (CI) -0.94 to 0.01; low-quality evidence). We are uncertain about the effect of desmopressin on major adverse events at short-term follow-up (risk ratio (RR) 0.97, 95% CI 0.10 to 9.03; very low-quality evidence). For intermediate-term follow-up (three to 12 months), desmopressin may reduce the number of nocturnal voids in an appreciable number of participants (MD -0.85, 95% CI -1.17 to -0.53; low-quality evidence). Desmopressin may result in little or no difference in major adverse events at intermediate-term follow-up (RR 3.05, 95% CI 0.13 to 73.39; low-quality evidence). We found no evidence on quality of life. Subgroup analyses suggest a larger effect with oral, higher-dose formulations of desmopressin and in men with documented nocturnal polyuria.

Desmopressin versus behavior modification: there were no data regarding the effect on the number of nocturnal voids, quality of life, or major adverse events.

Desmopressin versus alpha-blocker: based on short-term follow-up, desmopressin likely has a similar effect on the number of nocturnal voids (MD 0.30, 95% CI -0.20 to 0.80; moderate-quality evidence) and quality of life (MD 0.00, 95% CI -0.35 to 0.35; moderate-quality evidence). There were no major adverse events in either study group.

Desmopressin plus alpha-blocker versus alpha-blocker alone: based on short-term follow-up, combination therapy likely results in a small, unimportant reduction in the number of nocturnal voids (MD -0.47, 95% CI -0.73 to -0.21; moderate-quality evidence) and quality of life (MD -0.29, 95% CI -0.51 to -0.07; moderate-quality evidence). The risk of major adverse events may be similar (RR 0.30, 95% CI 0.01 to 7.32; low-quality evidence).

Desmopressin plus alpha-blocker versus alpha-blocker plus an anticholinergic: based on short-term follow-up, combination therapy likely results in little or no difference in the number of nocturnal voids (MD -0.43, 95% CI -0.97 to 0.11; moderate-quality evidence). We found no evidence on quality of life. There were no major adverse events in either study group.

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